Sobering reality of palliative care provision for patients with advanced chronic obstructive pulmonary disease

摘要

Chronic obstructive pulmonary disease (COPD) isa major cause of disability, impaired quality of life,and premature mortality in old age.1,2 Patientswith advanced COPD are most likely to experiencesymptoms of excessive dyspnea with minimal exertion,generalized pain, elevated psychologicaldistress and fatigue, and increased comorbidities.3-5These, cumulatively or individually, mayincrease disability, acute exacerbations, the use ofemergency care, and admissions to the hospitaland intensive care facilities.6,7 There is a growinginterest and awareness of the value of integratedpalliative care alongside usual care, as shown byrecent national and international COPD guidelinesthat recommend palliative care (PC) andadvance care planning (ACP) as part of a holistic,patient-?centered, and disease-?directed care forpatients with advanced COPD.8,9 However, thereare limited data available on the use of PC and accessto a PC specialist for patients with advancedCOPD as part of end-?of-?life (EOL) care in the yearsor months prior to death as compared with cancerpatients. This is in part due to the lack of accessto PC services (for nonmalignant diseases),lack of adequate training, prognostic uncertaintyas to when to provide PC for patients with advancedCOPD by clinicians, including other subtlebarriers as shown in TABLE 1. In contrast, a recentsystematic review and meta-?analysis in patientswith advanced cancer showed that PC was relatedwith reduced symptom burden and improvedquality of life in patients as well as increased caregiversatisfaction and reduced health care utilization.9,10Despite these promising results in patientswith advanced cancer, the unmet needs ofPC for patients with advanced COPD often remainunaddressed.